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Q1Group 2017 MA/MADP Analysis: A few more 2017 Medicare Advantage plan choices, but fewer PFFS and MMP options.




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Q1Group 2017 MA/MADP Analysis: A few more 2017 Medicare Advantage plan choices, but fewer PFFS and MMP options.

Published on 2016-10-03 15:18:00Category: Annual Medicare plan changes

The total number of 2017 Medicare Advantage plans will increase slightly across the country with 3% more Medicare Advantage plans in 2017. (Updated 10/25/2016 with newly released Medicare Advantage plan information.)
  • Brief review:  Medicare Advantage plans come in two general forms, MAs (Medicare Advantage plans that do not include prescription drug coverage) and MAPDs or Medicare Advantage plan that includes prescription drug coverage (MAPD).  A Medicare Advantage plan (MA or MAPD) includes your Medicare Part A (in-patient and hospitalization coverage), Medicare Part B (out-patient and physician coverage), and may include additional healthcare benefits (basic dental, optical, hearing, and/or fitness coverage) - an MAPD also includes Medicare Part D drug coverage.  If you enroll in a Medicare Advantage (MA) that does not include drug coverage, you may not be permitted to also join a stand-alone Medicare Part D plan (PDP) (so be sure to check before you join).
  • Overall, there will be 2,687 Medicare Advantage plans (MAs and MAPDs) available in 2017, as compared to 2,620 Medicare Advantage plans offered in 2016.
  • Most (90%) of 2017 Medicare Advantage plans will include prescription drug coverage (MAPDs).  In fact, a few more 2017 Medicare Advantage plans will include prescription drug coverage (MAPD) as compared to 2016.
  • However, slightly fewer 2017 Medicare Advantage plans without prescription coverage (MA) will be offered as compared to 2016.
  • The majority (around 71%) of 2017 Medicare Advantage plans will be HMOs (Health Maintenance Organizations).
  • Almost 20% of 2017 Medicare Advantage plans will be Local PPOs (Preferred Provider Organizations).  Medicare Advantage Local HMOs show the greatest increase in the total number of 2017 plans (with the addition of 55 Local HMO plans).
  • The number of Private Fee for Service (PFFS) Medicare Advantage plans continues to decline in 2017 (a 16% decrease in PFFS plans).  As a note, in 2015, the number of PFFS Medicare Advantage plans decreased by 43% (with PFFS Medicare Advantage plans offering prescription drug coverage decreasing by 66% or losing 33 PFFS MAPD plans in 2015) and have continued to decrease since that time.

Jump to 2013 - 2017 MAPD Plan chart
Jump to 2013 - 2017 MA Plan chart
Jump to Health Plan Type definitions

Change in the Number of All Medicare Advantage Plans
(MA & MA-PD)
  Number of Medicare Advantage Plans (MA & MA-PD)
Health Plan Type 2017 2016 Change ’16 to ‘17 2015 2014
Cost 77 81 -4 -5% 86 87
Local HMO 1,920 1,865 55 3% 1,785 1,763
Local PPO 515 487 28 6% 493 540
Regional PPO 61 58 3 5% 54 58
All PPOs 576 545 31 6% 547 598
PFFS 48 57 -9 -16% 69 120
MSA 4 4 0 0% 7 6
MMP 62 68 -6 -9% 32 4*
Total MA & MAPD plans 2,687 2,620 67 3% 2,526 2,578

    *Note: this is number of MMP plans in the September, 2013 landscape file

161025_MA_Type_total.jpg

 

Reminder: Types of Medicare Advantage Plans
As you browse through the 2017 Medicare Advantage plans, you will see in our Medicare Advantage search tools that there are seven common types of Medicare Advantage plans offered.
  • HMO - Health Maintenance Organizations:  HMOs are wellness based Medicare Advantage plans and usually have the most-restrictive healthcare provider network, meaning that your healthcare costs may be considerably higher if you go outside of your plan’s established network.  Also, depending on your HMO plan, you may only be allowed outside of your plan network with a referral from your doctor.  Local HMOs are often very affordable compared to other Medicare Advantage plans because the restrictive network and focus on wellness helps to control healthcare costs.  The majority of 2017 Medicare Advantage plans will be HMOs (Health Maintenance Organizations).
     
  • HMO POS - Health Maintenance Organizations Point-of-Service:  These Medicare Advantage HMO’s have a more flexible healthcare network allowing you to seek care outside of your plan’s network by paying a higher cost-sharing rate.  This type of HMO is chosen often for people who travel part of the year, but still return home for the majority of their healthcare needs.  For instance, you may have a $30 co-payment when you visit a healthcare provider in-network (at home) and pay $60 when you visit a provider outside of the plan’s network (while traveling).  Important: A few 2016 HMO POS plans will convert to HMOs (without the POS option) in 2017.  Please note, depending on your HMO POS, you may find that out-of-network costs do not apply to your plan's that your Maximum Out of Pocket (MOOP) limit - check with your plan's Member Services for more details.
     
  • PPO - Preferred Provider Organization:  Medicare Advantage PPOs have a less-restrictive provider network, but again, you probably will pay a higher cost-sharing rate when you visit a healthcare provider outside of your plan’s network.
     
  • PFFS - Private Fee for Service plans:  Although popular several years ago, fewer Medicare Advantage PFFS plans are now available (only 48 PFFS plans are available in 2017).  PFFS plans have the most flexible network, meaning that you can go to any health care provider as long as they accept Medicare and the terms and conditions of your PFFS plan.  As noted, in 2017, PFFS plans will continue to be rare, but some people still find PFFS plans as a flexible and economic alternative to other Medicare Advantage plans.
     
  • SNPs - Special Needs Plans:  SNPs are Medicare Advantage plans designed for a people with specific conditions or financial needs.  Certain SNPs are available only to diabetics, people with chronic cardiac conditions, nursing home residents, or people eligible for both Medicare and Medicaid (D-SNPs).  If you do not have the plan’s “special need”, you will not be allowed to join one of these plans.
     
  • MSAs - Medical Savings Accounts:  MSAs are like Health Savings Accounts (or HSAs) or a high-deductible health plan combined with a spending account that you can use to pay for your health care costs.  MSAs do not provide prescription drug coverage and you would need to join a separate Medicare Part D plan for your prescription needs.  Unfortunately, few MSAs are available.
     
  • MMPs - Medicare-Medicaid Plans:  MMP plans were introduced in 2014 and are only offered in a few locations across the country.  As noted by CMS: "A Medicare-Medicaid Plan (MMP) [like a D-SNP] is a private health plan that has been competitively selected and approved to provide integrated care to eligible full-benefit Medicare-Medicaid enrollees under the CMS Financial Alignment Demonstration." (CMS, “Financial Alignment Initiative,” (www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/FinancialModelstoSupportStatesEffortsinCareCoordination.html.) 
    MMPs only serve full benefit dual (Medicare/Medicaid) eligible beneficiaries and some additional limitations may apply.

Change in the Number of MA-PD Plans
  Number of Medicare Advantage Plans With Drug Coverage
Health Plan Type 2017 Change
’16 to ‘17
2016 Change
’15 to ‘16
2015 Change
’14 to ‘15
2014
Cost 33 -1 34 -5 39 0 39
Local HMO 1,785 53 1,732 83 1,649 40 1,609
Local PPO 479 38 441 0 441 -29 470
PFFS 32 -6 38 -12 50 -33 83
Regional PPO 44 3 41 4 37 -1 18
MMP 62 -6 68 36 32 -2 34
Total MAPD Plans 2,435 81 2,354 138 2,216 -3 2,219

 

161025_MA_Type_MAPD.jpg



As compared to the 2,435 MAPDs or Medicare Advantage plans that provide prescription drug coverage in 2017, there are only 252 different 2017 MAs or Medicare Advantage plans that offer health coverage only (no prescription drug coverage).  And across the country, there will be 14 fewer MA plans in 2017.

Change in the Number of
Medicare Advantage Plans Without Drug Coverage

Number of Plans
Health Plan Type 2017 Change
’16 to ‘17
2016 Change
’15 to ‘16
2015 Change
’14 to ‘15
2014
Cost 44 -3 47 0 47 -1 48
Local HMO 135 2 133 -3 136 -18 154
Local PPO 36 -10 46 -6 52 -18 70
MSA 4 0 4 -3 7 1 6
PFFS 16 -3 19 0 19 -1 37
Regional PPO 17 0 17 0 17 -1 18
Total MA Plans w/o Rx Cov. 252 -14 266 -12 278 -55 333

 

161025_MA_Type_MA.jpg

 

Other resources
2017 Medicare Advantage plan information is available in our 2017 Medicare Advantage plan finder (or MA-Finder) that can be found at: MA-Finder.com/2017

You can also see how each 2016 Medicare Advantage plan is changing in 2017 using our Medicare Advantage comparison tool found at: MA-Compare.com/2017.

Reminder: October 15th starts the annual Open Enrollment Period
The annual Medicare Open Enrollment Period (or Annual Coordinated Election Period) for 2016 Medicare Part D plans and Medicare Advantage plans begins on Saturday, October 15th and continues through Wednesday, December 7th, with 2017 Medicare plan coverage beginning on Sunday, January 1, 2017.

For more information, you can telephone Medicare at 1-800-633-4227 to speak with a Medicare representative.




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  • The Medicare Advantage and Medicare Part D prescription drug plan data on our site comes directly from Medicare and is subject to change.
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  • The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan.
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  • We make every effort to show all available Medicare Part D or Medicare Advantage plans in your service area. However, since our data is provided by Medicare, it is possible that this may not be a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.
  • When enrolling in a Medicare Advantage plan, you must continue to pay your Medicare Part B premium.
  • Medicare beneficiaries with higher incomes may be required to pay both a Medicare Part B and Medicare Part D Income Related Monthly Adjustment Amount (IRMAA). Read more on IRMAA.
  • Medicare Advantage plans that include prescription drug coverage (MAPDs) are considered Medicare Part D plans and members with higher incomes may be subject to the Medicare Part D Income Related Monthly Adjustment Amount (IRMAA), just as members in stand-alone Part D plans. In certain situations, you can appeal IRMAA.
  • You must be enrolled in both Medicare Part A and Part B to enroll in a Medicare Advantage plan. Members may enroll in a Medicare Advantage plan only during specific times of the year. Contact the Medicare plan for more information.
  • If you are enrolled in a Medicare plan with Part D prescription drug coverage, you may be eligible for financial Extra Help to assist with the payment of your prescription drug premiums and drug purchases. To see if you qualify for Extra Help, call: 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/ 7 days a week or consult www.medicare.gov; the Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or your state Medicaid Office.
  • Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
  • A Medicare Advantage Private Fee-for-Service plan (PFFS) is not a Medicare supplement plan. Providers who do not contract with the plan are not required to see you except in an emergency.
  • Disclaimer for Institutional Special Needs Plan (SNP): This plan is available to anyone with Medicare who meets the Skilled Nursing Facility (SNF) level of care and resides in a nursing home.
  • Disclaimer for Dual Eligible (Medicare/Medicaid) Special Needs Plan (SNP): This plan is available to anyone who has both Medical Assistance from the State and Medicare. Premiums, co-pays, co-insurance, and deductibles may vary based on the level of Extra Help you receive. Please contact the plan for further details.
  • Disclaimer for Chronic Condition Special Needs Plan (SNP): This plan is available to anyone with Medicare who has been diagnosed with the plan specific Chronic Condition.
  • Medicare MSA Plans combine a high deductible Medicare Advantage Plan and a trust or custodial savings account (as defined and/or approved by the IRS). The plan deposits money from Medicare into the account. You can use this money to pay for your health care costs, but only Medicare-covered expenses count toward your deductible. The amount deposited is usually less than your deductible amount, so you generally have to pay out-of-pocket before your coverage begins.
  • Medicare MSA Plans do not cover prescription drugs. If you join a Medicare MSA Plan, you can also join any separate (stand-alone) Medicare Part D prescription drug plan
  • There are additional restrictions to join an MSA plan, and enrollment is generally for a full calendar year unless you meet certain exceptions. Those who disenroll during the calendar year will owe a portion of the account deposit back to the plan. Contact the plan provider for additional information.
  • Medicare beneficiaries may enroll through the CMS Medicare Online Enrollment Center located at www.medicare.gov.
  • Medicare beneficiaries can file a complaint with the Centers for Medicare & Medicaid Services by calling 1-800-MEDICARE 24 hours a day/7 days or using the medicare.gov site. Beneficiaries can appoint a representative by submitting CMS Form-1696.